Associate feature: A Scotland where everybody thrives
In the midst of a worldwide pandemic and the biggest public health crisis the country had faced in a century, Public Health Scotland (PHS) came into existence – and it had no choice but to hit the ground running.
The new national public health agency has been at the heart of tackling COVID-19 right from its launch on 1 April, supporting the response to the pandemic in Scotland.
But while this role is at the forefront of PHS’s work, it doesn’t mean that all other public health priorities have taken a back seat.
In fact, quite the opposite is true. The virus has only served to cement the organisation’s founding principles of increasing healthy life expectancy, reducing premature mortality and reducing avoidable health inequalities, and it has brought a renewed focus on the areas which can make the biggest difference to the public’s health: mental wellbeing, communities and place, and poverty and children.
“Public Health Scotland was established this year as a new national public health body for Scotland, with a clear ambition to improve population health,” says Claire Sweeney, Director of Place and Wellbeing. “Our real focus is on helping to build a Scotland where everybody thrives.
“The issues that we’ve always had in Scotland in terms of the health of the population have continued and been accentuated by the COVID pandemic. That includes the economic challenges that we know are going to continue to be a big issue and have an impact on health across the Scottish population, probably for a very long time. It’s putting our contribution into even sharper focus.
“We are carrying out work on COVID and that isn’t just on the immediate health protection response, it is about the longer term impact of COVID on things like Scotland’s economy, society and health and social care services, and getting the system back in a better place.
“This is alongside our work on place and communities: so developments like how to build a 20-minute neighbourhood, how to make a great local community that people want to live in and be involved in. All of those things just become so much more important and I would argue so much more possible, at this time because we’ve been through COVID.”
Sweeney says reducing poverty is critical to of all PHS’s work and the challenges of the pandemic have made this all the more apparent.
“We know that living in poverty is a significant determinant of physical and mental health, and that the people who live in our most deprived communities bear the greatest burden,” she tells Holyrood. “That forms a core part of our work over the next few years.
“Reducing poverty and improving access to services for the most deprived people in our communities will help improve outcomes across the whole of Scotland, so it’s no surprise that poverty and inequality is right through the strategic plan we published earlier in the year.”
At national level PHS is working to identify, evaluate and share practical actions which work to reduce poverty, and at local level PHS is working with local partners to make sure the money spent by the public sector in Scotland is used in the best possible way.
But the challenges are numerous, and making sure those who are most in need actually get access to the services they need is vital.
This is why partnership working is incorporated into everything PHS does.
The agency is jointly sponsored by COSLA and the Scottish Government and collaborates across the public and third sectors.
“We see ourselves as having a key role in supporting partners, we’ve been quite explicit in our strategic plan,” says Sweeney. “And by that I mean, local government, Scottish Government, the police, with the health sector, local public health teams, voluntary sector partners and working with communities. So we’re bringing part of the story, a bit of the jigsaw, but we’re not bringing the whole of it – working in partnership will be the thing that makes us succeed.”
Jane O’Donnell, Director of People Policy at COSLA, says local government plays a vital role in addressing the impact of poverty and deprivation.
“COSLA and local authorities have always adopted a public health approach to how we do things,” explains O’Donnell. “We need to look at how we house people, how we support people economically, how we support local businesses.
“Local government is absolutely key to all of that and I think what I would say is, in terms of the pandemic, what we’ve seen so far in COSLA is that those people who have low incomes or are in precarious jobs are now finding these jobs being swept away or becoming more part-time or more perilous, and those people who are unemployed or seeking jobs find the labour market more squeezed and it’s far harder to become economically active.
“So the poverty dynamic is heading in the wrong direction, and Public Health Scotland working alongside local authorities will be able to make a big impact on that in the next year or so.”
O’Donnell says it is more important now than ever before that the people who are most impacted by deprivation are part of the process to help them out of poverty.
“If you really want to change how people’s lives feel, then you need to empower them and give them some agency,” she explains. “Public Health Scotland and COSLA are united in terms of giving that agency back to people on the ground and saying, the decision is yours around your green spaces, how you want to design your communities and services you receive.
“And I think that’s such an important point that it’s not about organisations doing things to people, what we are doing in our partnership between COSLA and Public Health Scotland is we are empowering people to tell us what they want their environment and services to look like.
“There’s a really big opportunity coming next year with the local governance review between Scottish Government and COSLA, and Public Health Scotland will be involved in everything we’re going to do around that. We’re going to ask communities to tell us how they would redesign services – and not just council services. How they would redesign health services, how they would redesign economic services, the colleges around them. Something really exciting is going to happen.”
Sweeney agrees that the key to change is empowerment and working on making the wider community a healthy and safe place to live. It’s about viewing the bigger picture.
“Our teams think very deeply with their partners about if you want to improve mental health, for example, it’s not only about having a strong mental health treatment system, that it is equally about making sure that people feel empowered to make decisions that affect their lives, that they have fair work, that there are more local enterprises, that there’s a sense of social value and environmental responsibility, that basically communities are in charge.
“It’s causing quite a change in the way we think about it, actually, which is really, really exciting.”
Eight months in and both Sweeney and O’Donnell are still incredibly enthusiastic and passionate about the establishment of the new national health agency and what improvements it will bring to people in Scotland.
In September, PHS launched its first strategic plan and its foundations include an inclusive economy with good work; quality housing and education; accessible and effective health and social care services; clean open spaces and water and sanitation.
“What we’ve tried to do in our strategic plan is to recognise that there are some things that make more of a difference to people’s lives so we can focus our resources around those,” explains Sweeney.
“As a new organisation, it gives us a perfect opportunity to build programmes of work with our partners in response to local need. We are in a really pivotal stage in our development at the moment. We are working through how we support economic development, what a wellbeing economy looks like, and we’re also thinking about things like food insecurity and what can make a difference for people with particularly low incomes and how we get more of a human rights view on that.
“We know that physical inactivity, for example, is one of the leading causes of premature death in Scotland, and we also understand very well how a person’s activity levels is influenced by lots of different factors such as where they live, their employment status, their financial circumstances, how easy it is to access the environment generally. We are working with partners around that to see what needs to change to help them.”
O’Donnell believes the establishment of PHS is a “big opportunity for the country” and says COSLA will ensure it “amplifies this new voice and the capabilities that’s bringing to the whole country”.
“They are looking at things in quite a radical new way.”
This article was sponsored by Public Health Scotland